Background and Purpose-The prevalence of poststroke depression is known to be high, but the knowledge of its neuropsychological correlates is limited. This 12-month prospective study was designed to evaluate the natural history of poststroke depression and to study its neuropsychological, clinical, and functional associates. Methods-We studied a series of 106 consecutive patients (46 women and 60 men, mean age 65.8 years) with acute first-ever ischemic stroke. The patients underwent a neurological, psychiatric, and neuropsychological examination at 3 and 12 months after the stroke. The psychiatric diagnosis of depression was based on DSM-III-R-criteria. Results-Depression was diagnosed in 53% of the patients at 3 months and in 42% of the patients at 12 months after the stroke. The prevalence of major depression was 9% at 3 months and 16% at 12 months. There was an association between poststroke depression and cognitive impairment; the domains most likely to be defective in stroke-related depression were memory (Pϭ0.022), nonverbal problem solving (Pϭ0.039), and attention and psychomotor speed (Pϭ0.020). The presence of dysphasia increased the risk of major depression. The depressive patients were more dependent in ADL and had more severe impairment and handicap than the nondepressive patients. Conclusions-More than half of the patients suffer from depression after stroke, and the frequency of major depression seems to increase during the first year. In addition to dysphasia, poststroke depression is correlated with other cognitive deficits. We emphasize the importance of psychiatric evaluation of stroke patients. (Stroke. 1999;30:1875-1880.)

Aphasia, depression, and cognitive dysfunction are common consequences of stroke, but knowledge of their interrelationship is limited. This 1-year prospective study was designed to evaluate prevalence and course of post-stroke aphasia and to study its psychiatric, neurological, and cognitive correlates. We studied a series of 106 consecutive patients (46 women and 60 men, mean age 65.8 years) with first-ever ischaemic brain infarction. The patients were clinically examined, and presence and type of aphasia were evaluated during the 1st week after stroke and 3 and 12 months later. Psychiatric and neuropsychological evaluations were performed 3 and 12 months after stroke. Aphasia was diagnosed in 34% of the patients during the acute phase, and two thirds of them remained so 12 months later. Seventy percent of the aphasic patients fulfilled the DSM-III-R criteria of depression 3 months and 62% 12 months after stroke. The prevalence of major depression increased from 11 to 33% during the 12-month follow-up period. The non-verbal neuropsychological test performance in the aphasic patients was significantly inferior to that of the patients with dominant hemisphere lesion without aphasia. One third of the patients with ischaemic stroke suffer from communicative disorders which seem to increase the risk of depression and non-verbal cognitive deficits. Although the prevalence of depression in aphasic patients decreases in the long term, the proportion of patients suffering from major depression seems to increase. We emphasize the importance of the multidimensional evaluation of aphasic stroke patients.

SUMMARY A prospective 5 years' neuropsychological, neurological, cardiological and electroencephalographkal follow-up study was carried out in 44 patients who had undergone open-heart surgery for valve replacement. A distinct interrelationship was found between the clinical outcome immediately after operation and the neuropsychological long-term course despite the rapid recovery of occasional clinical disorders related to operative procedures. In fact, the psychometric performance scores of those who did not develop clinical signs of cerebral dysfunction induced in operation showed a significant difference only years after operation. Similarly, the harmful effects of long perfusion time (ertracorporeal circulation) in operation were reflected in the long-term neuropsychological performance. Some evidence seemed to suggest that the correction of the prolonged circulatory disorder might possibly afford real enhancement of higher cerebral functions. The long-term results not only emphasize the importance of a careful clinical evaluation but also emphasize the necessity of considering the subclinteal level of events both before and after operation when assessing the overall outcome and cerebral safety of cardiac surgery patients.Stroke Vol 17, No 3, 1986CENTRAL NERVOUS SYSTEM (CNS) dysfunction has occasionally cast a shadow over the results of cardiac surgery. The development of surgical and anaesthesiological equipment has notably improved cerebral safety, and the occurrence of severe complications has become rare.'" 4 The well-being of the CNS, however, has not become self-evident and secure because several potentially harmful factors always remain in such complicated procedures as open-heart operations. It must also be emphasized that when only clinical criteria have been used to evaluate the CNS outcome, the appraisal of the results seems to have been too optimistic. 43 Clinical measures have been shown to provide only a narrow view over the actual CNS events, for the involvement of the subclinical levels has been revealed in electroencephalographical (EEG), 6 " 10 neuropsychological,"" 18 psychiatric 19 and radiological 20 studies.Previous studies investigating the long-term outcome of open-heart operations have concentrated their attention on cardiological and surgical aspects. "29 By contrast, the outcome of the higher cerebral functions has been given little attention, the earlier investigations having focused on describing the prevalence, nature and determinants of immediate postoperative disturbances using follow-up times limited to a few weeks or months."' l3 ' 16 Frank et al 16 performed a 6 months' study after operation and reported improvement in all the measured areas of intellectual performance. Preoperative anxiety seemed to worsen the improvement, probably by rendering the patients less apt to recall the test items. The intellectual changes were independent of cardiac functional measures. It was concluded that the observed improvement was only due to practice effects and that improved cerebral perf...

To investigate amyloid accumulation by carbon 11-labeled Pittsburgh Compound B (11 C-PiB) in hereditary cerebral amyloid angiopathy and APP locus duplication. Design, Setting, and Patients: Positron emission tomography with 11 C-PiB and magnetic resonance imaging were performed for 2 patients, 49-year-old and 60-yearold siblings with APP locus duplication, with hereditary Alzheimer disease and cerebral amyloid angiopathy. Main Outcome Measure: Change in 11 C-PiB uptake. Results: Uptake of 11 C-PiB was increased especially in the striatum (caudate nucleus to 225% and 280% of the control mean and putamen to 166% and 185% of the control mean) and in the posterior cingulate (to 168% and 198% of the control mean), and it was marginally increased in other cortical brain areas. The pattern of increased 11 C-PiB uptake was different from that seen in sporadic Alzheimer disease. Conclusions: Amyloid imaging with 11 C-PiB positron emission tomography is a useful tool for detecting in vivo amyloid accumulation in patients with hereditary cerebral amyloid angiopathy. However, the pattern of 11 C-PiB accumulation differs between patients with typical AD and patients with APP locus duplication.